Cutaneous pseudolymphoma is an uncommon, benign lymphoproliferative disorder of the skin. Although this condition is most commonly idiopathic, its occurrence has been associated with cosmetic tattoos. We report a unique case of cutaneous pseudolymphoma that occured after accidental, traumatic inoculation of a red pigment in a healthy 33-year-old woman.
Adult ; Betamethasone ; analogs & derivatives ; therapeutic use ; Biopsy ; Coloring Agents ; adverse effects ; Female ; Forehead ; pathology ; Humans ; Lacerations ; Lymphoproliferative Disorders ; diagnosis ; etiology ; Pseudolymphoma ; chemically induced ; diagnosis ; Skin ; pathology ; Skin Diseases ; chemically induced ; diagnosis ; Triamcinolone Acetonide ; therapeutic use

Acne Vulgaris ; chemically induced ; drug therapy ; Administration, Topical ; Adolescent ; Adrenal Cortex Hormones ; administration & dosage ; therapeutic use ; Anti-Bacterial Agents ; administration & dosage ; adverse effects ; therapeutic use ; Doxycycline ; administration & dosage ; adverse effects ; therapeutic use ; Drug Therapy, Combination ; Humans ; Isotretinoin ; administration & dosage ; therapeutic use ; Male ; Thorax

INTRODUCTIONWe assessed the pedagogical value of a student-led community-based experiential learning project called the Public Health Screening (PHS) run by medical and nursing students of the National University of Singapore's Yong Loo Lin School of Medicine (NUS YLLSoM).

MATERIALS AND METHODSWe conducted a cross-sectional study using a self-administered anonymised questionnaire on medical and nursing students who participated in PHS using the Fund for the Improvement of Postsecondary Education (FIPSE) Survey Instrument. Participants also gave an overall score for their learning experience at the PHS.

RESULTSThe participation rate was 93.1% (576/619) for medical students and 100% (37/37) for nursing students. All participants gave the PHS learning experience a high rating (median = 8 out of maximum of 10, inter-quartile range, 7 to 9). A majority of participants felt that PHS had helped them to improve across all domains surveyed. For medical students, those in preclinical years and females were independently more likely to feel that PHS had helped them to improve in communication skills, teamwork, ability to identify social issues, taking action, and gaining and applying their knowledge than those in clinical years and males. Improved ability to interact with patients (β=1.64, 95%CI, 1.01-2.27), appreciation of challenges to healthcare faced by Singaporeans from lower income groups (β=0.93, 95%CI, 0.49-1.37), thinking of others (β=0.70, 95%CI, 0.04-1.37) and tolerance of different people (β =0.63, 95%CI, 0.17-1.10) were strongly associated with the overall rating score.

CONCLUSIONPHS was a positive learning experience in a wide range of domains for all students involved. This suggests that student-organised community-based experiential learning projects have potential educational value for both medical and nursing students.

Attitude of Health Personnel ; Community Health Services ; organization & administration ; Confidence Intervals ; Cross-Sectional Studies ; Data Collection ; Education, Medical ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Learning ; Logistic Models ; Male ; Mass Screening ; Models, Educational ; Odds Ratio ; Program Development ; Program Evaluation ; Public Health Practice ; Schools, Medical ; Singapore ; Students, Medical ; Students, Nursing ; Surveys and Questionnaires ; Teaching ; Volunteers

Asia ; COVID-19 ; Humans ; Ophthalmologists ; Perception ; SARS-CoV-2

Introduction: Atrial fibrillation (AF) is the most commoncardiac arrhythmia with significant morbidity and mortalityin relation to thromboembolic stroke. Our study aimed toevaluate the safety and efficacy of dabigatran in strokeprevention in elderly patient with nonvalvular AF with regardto the risk of ischemic stroke and intracranial haemorrhage(ICH) in real-world setting.Methods: A retrospective cohort study of 200 patients ondabigatran and warfarin from January 2009 till September2016 was carried out. Data were collected for 100 patients ondabigatran and 100 patients on warfarin.Results: The mean follow-up period was 340.7±322.3 daysfor dabigatran group and 410.5±321.2 days for warfaringroup. The mean time in therapeutic range (TTR) was52±18.7%. The mean CHA2DS2 -VASc score for dabigatrangroup was 4.4±1.1 while 5.0±1.5 for warfarin group. None indabigatran group experienced ischemic stroke compared toone patient in warfarin group (p=0.316). There was onepatient in dabigatran group suffered from ICH compared tonone in warfarin group (p=0.316). Four patients in warfaringroup experienced minor bleeding, while none fromdabigatran group (p=0.043).Conclusion: Overall bleeding events were significantly lowerin dabigatran group compared to warfarin group. In thepresence of suboptimal TTR rates and inconveniences withwarfarin therapy, non-vitamin-K antagonist oralanticoagulants (NOAC) are the preferred agents for strokeprevention in elderly Asian patients for nonvalvula

INTRODUCTION: There are limited studies exploring functional improvement in relation to characteristics of patients who, following acute hospital care, receive inpatient rehabilitation in community hospitals. We evaluated the association of acute hospital admission-related factors with functional improvement on community hospital discharge. METHODS: We conducted a retrospective cohort study among patients who were transferred to community hospitals within 14-day post-discharge from acute hospital between 2016 and 2018. Modified Barthel Index (MBI) on a 100-point ordinal scale was used to assess functional status on admission to and discharge from the community hospital. We categorised MBI into 6 bands: 0-24, 25-49, 50-74, 75-90, 91-99 and 100. Multivariable logistic regression models were constructed to determine factors associated with categorical improvement in functional status, defined as an increase in at least one MBI band between admission and discharge. RESULTS: A total of 5,641 patients (median age 77 years, interquartile range 69-84; 44.2% men) were included for analysis. After adjusting for potential confounders, factors associated with functional improvement were younger age, a higher MBI on admission, and musculoskeletal diagnosis for the acute hospital admission episode. In contrast, a history of dementia or stroke; lower estimated glomerular filtration rate; abnormal serum albumin or anaemia measured during the acute hospital episode; and diagnoses of stroke, cardiac disease, malignancy, falls or pneumonia; and other chronic respiratory diseases were associated with lower odds of functional improvement. CONCLUSION Clinicians may want to take into account the presence of these high-risk factors in their patients when planning rehabilitation programmes, in order to maximise the likelihood of functional improvement.
Aftercare ; Aged ; Female ; Hospitals, Community ; Humans ; Inpatients ; Male ; Patient Discharge ; Retrospective Studies ; Stroke/complications* ; Stroke Rehabilitation

We report a case of a 61-year-old woman with a large atrial septal defect (ASD) that was detected incidentally on chest radiography and computed tomography when she presented with sepsis. Echocardiography confirmed a large secundum ASD with left-to-right shunt flow, right heart dilatation and severe pulmonary hypertension. The patient had a poor clinical outcome despite intensive care and eventually passed away. Haemodynamically significant ASDs have a known association with increased morbidity and mortality, and their early detection and closure cannot be understated. This article aimed to highlight the imaging features of ASD, with special emphasis on the routine chest radiograph. The pathophysiology and clinical manifestations of ASD are also briefly discussed.
Cardiomegaly ; complications ; diagnostic imaging ; Critical Care ; Female ; Heart Septal Defects, Atrial ; complications ; diagnostic imaging ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; complications ; diagnostic imaging ; Middle Aged ; Patient Admission ; Pulmonary Artery ; diagnostic imaging ; Radiography, Abdominal ; Radiography, Thoracic ; Sepsis ; complications ; diagnostic imaging ; Tomography, X-Ray Computed ; Young Adult

INTRODUCTIONThis study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined.

MATERIALS AND METHODSThe study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up.

RESULTSThe follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99).

CONCLUSIONAn access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.

Adult ; Age Factors ; Aged ; Antihypertensive Agents ; therapeutic use ; Asian Continental Ancestry Group ; statistics & numerical data ; Diet, Sodium-Restricted ; methods ; Exercise Therapy ; methods ; Female ; Health Services Accessibility ; statistics & numerical data ; Humans ; Hypertension ; diagnosis ; ethnology ; therapy ; Male ; Mass Screening ; Middle Aged ; Multivariate Analysis ; Patient Compliance ; ethnology ; statistics & numerical data ; Patient Dropouts ; statistics & numerical data ; Poverty ; statistics & numerical data ; Proportional Hazards Models ; Prospective Studies ; Risk Reduction Behavior ; Singapore ; Smoking Cessation ; methods ; Social Class ; Treatment Outcome ; Weight Reduction Programs ; methods